A Mount Sinai ophthalmologist will present new surgical technology that lets eye surgeons measure and respond to critical fluid dynamics inside the eye during surgery. The advance could significantly improve precision and outcomes in glaucoma and other eye procedures.
The technology, called miDOC (micro-interventional Dynamic Outflow Curve), addresses a major blind spot in glaucoma surgery. Currently, more than 50 percent of patients undergoing major glaucoma procedures fail to achieve complete success and medication independence. Often, surgeons don’t know if the procedure worked until follow-up appointments weeks later.
How does it work?
miDOC provides continuous measurement of eye flow and pressure during surgery – parameters that have historically been impossible to assess in real time. The system lets surgeons monitor changes and adjust procedures for each patient as they operate.
During surgery, miDOC measures key parameters including:
- Intraocular pressure changes
- Aqueous fluid outflow rates
- Pressure dynamics within different eye chambers
- Real-time response to surgical interventions
New York Eye and Ear Infirmary of Mount Sinai is the only eye center in the country using this technology. Surgeons started using it in patients in July 2025 and have completed the first 20 cases. All procedures were successfully completed with the system’s guidance.
Why does it matter?
The technology addresses a critical gap in glaucoma surgery precision. “This is the equivalent of what optical biometry did for cataract surgery. miDOC brings precision to glaucoma surgery that simply has not existed before,” says Dr. Sean Ianchulev, who developed the technology.
Without miDOC, glaucoma surgeons have no way to check a patient’s exact eye flow and pressure during surgery. They can only measure pressure before and after the procedure, leaving outcomes unpredictable.
This contrasts sharply with cataract surgery, where 95 percent of patients achieve successful outcomes within very small margins of error. That success comes from accurate measurement tools that guide the procedure.
The system also has potential applications beyond glaucoma:
- Identifying cataract surgery patients at risk for dangerous pressure spikes
- Detecting blood flow in the eye’s vascular supply
- Providing insights into cardiovascular and other body systems
The context
Dr. Ianchulev will present miDOC during the Charles D. Kelman Innovator’s Lecture at the American Society of Cataract and Refractive Surgery annual meeting in Washington, D.C. The lecture highlights visionary leaders in eye surgery.
The technology was developed at New York Eye and Ear Infirmary with funding from Mount Sinai Innovation Partners. Dr. Gautam Kamthan co-invented the system and leads the clinical study.
“Intraoperative measurement of aqueous outflow has not previously been possible during ophthalmic surgery. This capability has the potential to transform outflow-based surgical interventions,” says Dr. Kamthan.
The device is currently investigational and hasn’t received FDA clearance. Researchers plan to refine the technology and pursue regulatory approval for broader clinical use. Both inventors and Mount Sinai would benefit financially if the technology is approved and commercialized.